How healthy are the healthcare settings for transgender or hijra people?
June 7, 2012
The transgender, 'hijra' or 'kinnar' community is visible as usually its members can be spotted easily by way of their
attire and mannerisms. However they are invisible in the sense that society shuns them and does not even want to
acknowledge their existence. They face problems in all spheres of life. But, the impediments they face in accessing
quality healthcare services at times, cause irreparable physical and mental damage to them and may even be life
threatening.
Members of this forsaken community, along with civil society activists, recently met at a National consultation, aptly
called Hijra Habba (festival), held in Delhi, to voice their legitimate concerns and seek solutions to their problems
from the stakeholders and government officials present there. They had innumerable instances cite about the hardships
they face even in getting the minimal amount of medical attention, leave alone any proper counseling worth the name.
According to Ernest Noronha from the United Nations Development Programme (UNDP) India, “The hijras face a two pronged
problem within healthcare settings - one is the element of fear and the other is lack of knowledge. Even within the
medical fraternity there are a lot of misconceptions/misgivings about them - are they born without some organs; do they
have female organs; do they not have sexual organs? The examining doctor may not know what sexual organs the transgender
(TG) has and is not prepared for the shock he might get (I am not even talking of the nurses and other staffs at that
level because there is still more discrimination at that level). I strongly feel that the medical curriculum should have
adequate information on sexual and health issues. Many transgenders suffer from mental health problems like depression
and suicidal tendencies. So the doctor must understand what drives them towards such a state of despondency. They do not
have anything to fall back upon apart from some community structure. If you are excluded from your family and are living
in a pseudo family, if you do not have children, then what is there for you to look forward to, beyond your earning age
of 40 years? So healthcare professionals need to be more sensitized; communities need to be proactive; parents need to
understand and the government has to be serious in its efforts.”
Zeenat Pasha, a prominent Hijra guru from Mumbai and a founder member of the Dai Welfare Society, the first
community-based organization of Hijras in India, has been working with people living with HIV in the Kamathipura (red
light) area of Mumbai for the past 17 years. She is very vocal about the problems faced by transgenders who are HIV
positive, and rues that, “The government programs are limited to distribution of condoms and at the best admitting a
patient in a hospital in case of serious sickness. When hijras go to a hospital to seek treatment the first dilemma of
the doctor is whether to admit them in male ward or female ward. If the hijra is nirvana (they have got themselves
emasculated) he is sent to female ward. If he is not emasculated they are put in male ward. Seeing the devastation and
death caused by HIV/AIDS hijras are becoming more aware and are counseling each other to save themselves from HIV
related death. Earlier they had no knowledge about the benefits of condoms and about clean injection syringes. But now
they ensure that the doctor is using clean syringes; else they do not go to him. But only 30-35% hijras have become more
aware. So a lot more still needs to be done.”
Billy Stewart, Senior Health and AIDS Adviser at Department For International Development (DFID), UK, also agrees that:
“there is clearly a set of challenges about the transgender and hijra community to access a lot many services, including
health services. In India the counseling component is fairly weak across the board in health services, especially
regarding mental health issues. This is one of the challenges for the country to develop community based interventions
to deal with mental health requirement and counseling requirements of transgenders/hijras. The quality of health care
services and Sex Reassignment Surgery (SRS) services also needs to improve and become more responsive. Of course the
community will have to be engaged more for this. We need more articulate community members to come forward.”
James Robertson, Country Director of India HIV/AIDS Alliance informs that according to the best estimates available, the
number of transgenders in India is 750,000 and the high prevalence of HIV incidence in the community ( it is 30 to 60
times higher than in general population) poses a serious challenge to address their health. He cites the case of a
patient who was turned out from a West Bengal hospital even though she was suffering from sepsis after having undergone
Sex Reassignment Surgery (SRS). It was after a lot of advocacy at civil society level and community led protests that
finally they could find a hospital and doctor who could provide the care that she needed. James laments that, “Such
incidences should never happen and yet they are very common. We have a very long way to go. All of us have to become
more sensitive towards them. There should be more sensitization programmes for doctors, health workers, government
officials, policy makers. There should not only be sensitization but an understanding of the TG issue must be part of
the medical training which doctors, nurses and healthcare professionals undergo.”
Mujra is a Hijra activist from Mumbai who runs a support group for Hijras living with HIV from her home and attends to
those in need. She also provides quality peer counseling and yoga training to meet mental health needs of the TG and
Hijra community who are also infected with HIV. She is very vocal about the problems which the hijra community faces in
accessing treatment and healthcare services: “For them just to get tested for HIV/AIDS is a big issue. They do not get
motivated easily to go for testing. They have to be counseled a lot that being HIV positive is not the end of life and
that they can still live normally by taking medicines. Even when we convince the person to see a doctor, then we face
many problems at the time of registration for which some identification and address proof is required, and in the
absence of these documents registration cannot be done. All hijras do not possess such a proof. Similar problems occur
at DOTS (Directly Observed Treatment Shortcourse) centre, where residential address of the patient is a compulsory
requirement for registration. This is a big problem and I request the government to find a way out, as hijras are also a
part of society. Again, even if the doctor at the health centre says yes for admission, when they go to the ward then
the nurses and other staff reveal their identity and also wonder where they should keep the hijra. Then, other patients
in the ward also start discriminating.”
“There is virtually no counseling worth the while available at government level. The patient is just told when he/she
has to eat the medicines, and what nourishing diet is to be taken. But there is no quality counseling to equip the
patient to cope with the disease and the mental stress and other psychological problems arising out of it. I try to
counsel them on many aspects - mental, medicinal, etc. Here I would like to stress the importance of yoga in the
treatment of HIV. I have helped many patients to not start on antiretroviral (ARV) treatment just by making them do yoga
regularly. I think more community participation is needed to lessen our misery. Along with proper healthcare facilities
we also need some income generation activity for hijras.”
This meet was organized by Pehchan project in association with India HIV/AIDS Alliance.
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Shobha Shukla is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation
(NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto
Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices
from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. http://www.citizen-news.org